It Wasn't Ordered No abstract available

Measurement of Patients' Perceptions of the Quality of Acute Stroke Services: Development and Validation of the STROKE Perception Report INTRODUCTION Patients' perceptions of healthcare quality have become an important part of quality measurement. We explored patients' and family's lived experiences during acute stroke hospitalization to develop a quantitative instrument. METHODS Focus groups were conducted using open-ended scripted questions. Interview data were coded and analyzed using an inductive approach to thematic analysis. Symmetric patient and family instruments were developed based on qualitative domains and serially refined to a set of 30 survey items, 12 stroke knowledge test items, and 5 subject demographic fields. Scales were evaluated for internal consistency reliability using Cronbach α; construct validity with exploratory factor analysis using principal components with varimax rotation was performed to determine the extent to which items in a scale measure the same underlying factor. Feasibility of an electronic cloud-based survey was also tested. RESULTS Three main themes emerged: fast action to diagnose and treat stroke, genuine caring, and education to prevent and respond to stroke. A total of 1029 subjects completed the final instrument with no differences in perception found by race, ethnicity, or length of stay. Scales showed satisfactory internal consistency reliability (Cronbach α scores, .89–.94); factor loadings across each scale ranged from 0.55 to 0.87. Data entry by electronic pad was perceived by 77% to be more confidential than paper surveys; median score for difficulty was 4 (“easy to use”). CONCLUSION The STROKE Perception Report enables understanding of patients' and family's beliefs about the quality of acute stroke care in essential new domains never explored before.

A Comparison of Dressing Techniques for Presurgical Closure of Myelomeningocele in the Neonate BACKGROUND: Myelomeningoceles are routinely closed surgically within 24 to 48 hours after birth; the defect and exposed placode must be protected from further damage from excoriation and contamination until surgery. PURPOSE: Two methods to keep the defect moist and clean are used at our large Midwestern children's hospital: the occlusive and the drip. There was no agreement between the neonatal and neurosurgical teams as to which technique was superior, hence the need for a formal evaluation. METHODS: A prospective, randomized trial was conducted to compare the ease of nursing care, cost of supplies, neonatal temperature, and moisture of the placode at the time of closure in neonates with a myelomeningocele. RESULTS: Nurses categorized the occlusive group as easy care (100%) compared with 60% for the drip group, although the difference was not statistically significant (P = .18). The mean temperatures of the 2 groups before surgery were identical (36.9°C) in both groups. The cost of the drip was 6 times higher than that of the occlusive technique. The placode was assessed as moist in all 13 cases (100%). CONCLUSION: The occlusive technique was easier to care for by all the nurses and was 6 times more cost effective. Both methods kept the placode moist and did not affect the temperature of the baby.

A Multicenter Study on the Early Assessment of Functional Capacity of Patients With Brain Tumor After Surgery BACKGROUND: Brain tumors pose a great therapeutic problem as they cause the impairment of basic vital functions and disability of various levels. The goal of this research was to describe and compare the functional capacity of patients in an early period after surgical treatment of brain tumor. METHODS: This multicenter study includes 165 patients who underwent surgical treatment of brain tumor, hospitalized on neurosurgical wards in Poland. The research was based on the assessment of patients’ functional capacity measured with the Functional Capacity Scale (FCS). The patients were examined twice: first, on the day of admission and, second, on the day of discharge. Patient FCS scores were compared with the scores obtained using the Karnofsky Performance Scale and Glasgow Outcome Scale. RESULTS: The mean FCS score was 43.72 points on the day of admission and 43.07 points on the day of discharge from hospital (P > .05). The FCS was correlated with age (r = 0.373, P < .001) and consciousness level (r = −0.418, P < .001). A high correlation (P < .001) was found between the scales used for the assessment of functional capacity (r = 0.68–0.84). CONCLUSIONS: Most patients showed independence in terms of functional capacity on the day of discharge. Significant factors influencing patient functional capacity are age and level of consciousness. The use of the FCS allows for an accurate assessment of the functional condition of a patient and correlates with the Karnofsky Performance Scale and Glasgow Outcome Scale.

Relationship Between Anticoagulant Medication Adherence and Satisfaction in Patients With Stroke AIM: The aim of this study was to investigate the accuracy of the self-reported measure of adherence and the relation between adherence to warfarin use, demographic and clinical variables, and the satisfaction with the treatment in patients affected by stroke. METHODS: This is a correlational, quantitative, and cross-sectional study, carried out in the outpatient clinics of a public university hospital from October 2017 to April 2018. Sociodemographic and clinical data were collected through interviews and hospital charts, as well as by applying the Measurement of Treatment Adherence (MTA) and the Duke Anticoagulation Satisfaction Scale, in their Brazilian versions. Results of the international normalized ratio (INR) were collected. Measurements of accuracy of the MTA scale were calculated in relation to the INR classification. RESULTS: Of 99 patients (55.6% male with a mean age of 58.6 years), 57.6% presented with therapeutic INR values and 75.8% of the patients were adherent to the oral anticoagulant therapy according to the MTA. The accuracy analysis of the measurement provided by the MTA scale in relation to the INR classification showed a sensitivity of 77.2% and a specificity of 26.2%. The patients’ satisfaction with the treatment was high. The Duke Anticoagulation Satisfaction Scale had an average total score of 46.4, with the dimension impact in the field having the highest score (20.3). CONCLUSION: Stroke patients were adherent and satisfied with the oral anticoagulant therapy. The MTA had good sensitivity and poor specificity. Sociodemographic and clinical characteristics identified were not associated with adherence and satisfaction with treatment.

Relationship Between Anticoagulant Medication Adherence and Satisfaction in Patients With Stroke No abstract available

Pharmacogenomics of Cytochrome P450 of Nimodipine Metabolism After Aneurysmal Subarachnoid Hemorrhage INTRODUCTION: Aneurysmal subarachnoid hemorrhage (aSAH) is a type of stroke that is life threatening with high rates of mortality, and many survivors are left with permanent neurologic deficits. Nimodipine is the treatment of choice for aSAH with the goal of reduction of delayed cerebral ischemia. It is the only evidence-based medication that has been shown to have improved outcomes for delayed cerebral ischemia; therefore, it is important for neuroscience nurses to be knowledgeable of the pharmacology and pharmacogenomics properties of this medication, including cytochrome P450 (CYP450) enzymes. METHODS AND RESULTS: This article reviews the CYP450 enzyme system including a review of the pharmacotherapy and pharmacogenomics of nimodipine for patients with aSAH illustrated with case study of a patient with abnormal drug metabolism. CONCLUSION: CYP450 enzymes can be inhibited or induced by multiple medications resulting in clinically significant differences in drug metabolism. Food and Drug Administration–approved medication nimodipine is the only medication shown to improve outcomes in patients with aSAH. Hence, it is important to have awareness of potential drug-to-drug interactions and pharmacogenomics of nimodipine when caring for critically ill patients with aSAH.

Scholarship in Neuroscience Nursing BACKGROUND: Scholarship is a hallmark of all professions and includes research and practice scholarship. Building the science for practice and care is a major responsibility of each profession. METHODS: The purpose of this article is to define clinical science as it applies to neuroscience nursing as well as to establish the foundation for the work of the Clinical Science Committee of the American Association of Neuroscience Nursing. CONCLUSIONS: Research scholars conduct investigations for discovery of new knowledge. Practice scholars develop clinical knowledge through clinical practice and experience and an inquiring mindset that questions why and how certain methods or processes contribute to the achievement of certain outcomes; they look for better ways to improve processes of care and practice that will achieve optimal evidence-based outcomes. Scholarship in both research and practice domains is critical to the advancement of neuroscience nursing. Many opportunities exist for neuroscience nurses to contribute to clinical science.

Perception of Provision of Futile Care Among Clinicians in the Neuroscience Intensive Care Unit BACKGROUND: Futile care in the neuroscience intensive care unit (NSICU) can create moral distress for clinicians who may differ in their interpretation of the value of such care. We sought to compare the perception of provision of futile care in the NSICU among physicians, advanced practice providers, and intensive care unit registered nurses (ICURNs). METHODS: This is a cross-sectional study of 77 patients. A standardized questionnaire was used to ask clinicians whether care being provided to NSICU patients admitted for more than 48 hours was futile and whether they would want that treatment for their loved one. Demographics, diagnosis, and reason for treatment futility were collected. Futility was analyzed independently and in an aggregate manner (yes/probable combined and no/probable combined). RESULTS: The sample median age was 61 (SD, 17.179) years, men comprised 53% of the sample, and 68% were white. Collectively, there were 77 futile responses (33%), 136 nonfutile (59%), and 18 probable futile (8%). Physicians and nurse practitioners deemed futility in 36% of patients; ICURNs, in 27% (P < .05). Age, race, or diagnosis did not impact futility perception. The treatment was acceptable for a loved one in 53% of cases for physicians, 43% for advanced practice providers, and 48% for ICURNs (P < .05). Interobserver agreement for futility was 0.469 (CK), and pairwise agreement was 71%. Interobserver agreement for treatment acceptable for a loved one was 0.568 (CK), and pairwise agreement was 78%. CONCLUSIONS: Clinicians consider NSICU care futile in one-third of patients, but correlation among them is moderate; no specific variable is associated with such perception.

Validity and Reliability of the Turkish Version of the Amyotrophic Lateral Sclerosis Assessment Questionnaire OBJECTIVE The aim of this study was to adapt the Amyotrophic Lateral Sclerosis Assessment Questionnaire (ALSAQ), developed for the evaluation of quality of life in amyotrophic lateral sclerosis (ALS) patients, into the Turkish society. METHODS This methodological study was conducted in 92 ALS patients registered in 2 chapters (Istanbul and Izmir) of Turkish ALS-Motor Neuron Diseases Association. The expert opinion and forward-backward translation methods were applied for the linguistic validity of the ALSAQ (long and short versions: ALSAQ-40 and ALSAQ-5, respectively). RESULTS In the analysis of internal consistency, the Cronbach’s α reliability coefficient was .96 for the total scale, whereas it was between .88 and .98 for the 5 dimensions. The dimensions of the long form were correlated with the items of the short form. CONCLUSION The Turkish versions of the ALSAQ short and long forms are valid and reliable tools to be used in the assessment of the quality of life in ALS patients.